Twelve-year-old Olivia Luzinski of Springville, Iowa, smiles at her mother Ashley as registered nurse Janis Harrison puts pressure on the vaccination spot after Olivia got a vaccination during an appointment at the Mercy Pediatric Clinic, Monday, Aug. 20, 2018. (Jim Slosiarek/The Gazette)Gracelynn Watkinson (center), 12, reacts as she gets the third and fourth of four vaccinations by registered nurses Meredith Quinlan (left) and Stephanie Stecher during an appointment at the Mercy Pediatric Clinic, Monday, Aug. 20, 2018. (Jim Slosiarek/The Gazette)

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Less than half the students at a junior high school in Coralville two years ago had state-mandated immunizations against diseases such as meningitis, measles, mumps, hepatitis B and polio.

Northwest Junior High’s low rate was a wake-up call for the Iowa City Community School District, said Susie Poulton, the district’s health service coordinator. The district began “very deliberate efforts to improve the immunization rate,” she said.

“We’ve spent more time and effort contacting parents to help them access resources to get the immunizations needed for their children,” Poulton said. “That was the main step — calling and talking to parents.”

A state audit out this month showed the school’s immunization rate since has increased to almost 88 percent.

“Our rates aren’t bad, we still have work to do,” Poulton said. “But we’re keeping a close eye on it.”

Schools’ immunization rates come into focus this time of year as most students return to class. Students regularly arrive for the first day of school without the necessary vaccinations, though schools have until October or later before state compliance audits begin.

“It’s a huge focus right now,” Sandy Byard, Cedar Rapids Community School District health services facilitator, said last week as a new school year began. “State law requires students to have current and up-to-date immunizations or medical or religious exemptions on file for school compliance.”

In the past school year, almost all kindergarten through 12th grade students — 98.82 percent — in the state had a valid immunization certificate, and a handful of counties, including Delaware and Jefferson counties, had 100 percent immunization rate.

In Linn County. 98.98 percent of students have a valid certificates among its more than 39,000 students, and Johnson County saw 97.11 percent of its 19,600 students with full validated vaccines.

Improving a school’s immunization rate often means connecting parents to health providers, said school officials in both Iowa City and Cedar Rapids.

“We do a lot of work, a lot of pre-work, getting that information out in the spring,” Byard said. “There are a lot of resources we offer to parents to make sure they’re prepared to get those immunizations.”

Many schools in both districts also offer in-school clinics, where some students can receive free immunizations.

The public health department measures the rate of under- or unvaccinated children. That includes cases of medical and religious exemptions, provisional exemptions or an invalid or no immunization certificate.

Some counties, such as Decatur in southern Iowa, saw as much as 19.9 percent of students under or un-immunized.

Johnson County’s rate came in at 8.1 percent this past school year, and Linn County measured 5.7 percent of its kindergarten through 12th-graders without a full immunization certificate.

“We understand there’s exemptions, and that’s allowed,” Cedar Rapids Schools’ Byard said. “But the more people who are immunized, the healthier the entire community stays.”

RELIGIOUS EXEMPTIONS

In recent years, public health officials at the state and local level say they have seen a concerning increase in the number of religious exemptions, which are allowed if immunization “conflicts with a genuine and sincere religious belief,” according to the state public health department.

In the 2007-2008 school year, there were 0.53 percent of Iowa’s K-12 students with religious exemptions. The 2017-18 school year saw 1.68 percent.

In Linn and Johnson counties, many of those with the lowest immunization rates are private, religious schools — Cedar Valley Christian, Regina Junior-Senior High School, Isaac Newton Christian, St. Joseph and LaSalle Middle all have rates under 90 percent.

The Gazette

Linn County saw 1,016 religious exemptions among its students.

Of the total number enrolled in Johnson County, 299 were religious exemptions.

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Don Callaghan, chief of the Bureau of Immunization and TB for the state’s Department of Public Health, said Iowa is consistent with the rest of the nation in seeing an increase in religious exemptions for school-aged children — a trend the department continues to watch and to try to address.

“Any time we see an increase in children not being vaccinated, it is concerning,” he said.

While public health departments would rather 100 percent of children be vaccinated, Jennifer Miller, disease prevention specialist for Johnson County, said that’s not necessarily realistic.

“In public health, we would love to see 100 percent compliance of all children fully immunized, but you have to think about the reality of the importance of an education and allowing people religious freedom and the right to choose,” Miller said.

Some public health officials attributed the rise in religious exemptions and other under- or un-immunized children due to an “out-of-sight, out-of-mind” mentality. Outbreaks of vaccine-preventable diseases are not as common as they were years ago, Meador said.

“We don’t have children here in iron lungs in the hospitals anymore,” Meador said. “We don’t have massive measles outbreaks where you’re hearing about it every day in the news. We don’t see some of these anymore, so we forget. Maybe we don’t forget, because we don’t see it. It hasn’t been in our lifetimes.”

So the best option public health officials have in preparing for outbreaks is to be aware of schools and students that could be at most risk.

“That’s just knowledge we’re not going to be able to change that, it’s a legal option parents have,” Miller said. “It’s just being aware that’s the most important thing for us.”

*NOTE: In the above interactive visualizations, there is some concern regarding the accuracy of the Turkey Valley immunization rates. It is believed the data may be inaccurate due to a transcription error, according to Turkey Valley school officials and public health information from previous years.